Recommended Dosage of Bromhexine
The recommended dose of bromhexine is 8 mg three times daily for adults. 1, 2
Dosage Guidelines for Different Populations
- For adults with bronchiectasis or other respiratory conditions with thick mucus, the standard dose is 8 mg taken orally three times daily 1, 3
- Higher doses of 16 mg three times daily have been studied in clinical trials for chronic bronchitis with similar safety profiles 4
- Some studies have used 30 mg twice daily for chronic obstructive lung disease, showing statistically significant therapeutic activity compared to placebo 5
- For combination therapy with antibiotics during respiratory infections, the standard 8 mg three times daily dosage is maintained 6
Mechanism of Action and Clinical Effects
- Bromhexine functions as a mucolytic agent by increasing the production of serous mucus, making sputum thinner and less viscous 2
- This medication improves expectoration by reducing sputum viscosity, with studies showing significant improvement in sputum production at days 7,10, and 16 of treatment (mean difference -21.5 mL, 95% CI -38.9 to -4.1) 1
- Bromhexine also improves difficulty in expectoration as measured at day 10 of treatment (mean difference -0.53,95% CI -0.81 to -0.25) 1
- Studies show bromhexine can significantly reduce phlegm stickiness (p<0.05) and improve overall clinical state as judged by physicians 4
Safety Considerations
- Bromhexine is generally well-tolerated but may have more adverse events compared to placebo (OR 2.93,95% CI 0.12-73.97) 1, 2
- The European Respiratory Society suggests not using bromhexine routinely in children/adolescents with bronchiectasis due to potential adverse effects 1
- When used in combination with antibiotics, bromhexine maintains a favorable safety profile with minimal side effects 6
Clinical Application Guidelines
- Bromhexine should be administered before airway clearance techniques in patients with bronchiectasis, following this order if prescribed: bronchodilator → mucoactive treatment (bromhexine) → airway clearance → nebulized antibiotic 1
- Consider bromhexine particularly for patients with thick, tenacious mucus that is difficult to expectorate 2
- Bromhexine is not widely available in the UK and is not listed in the British National Formulary (BNF) 1
Special Considerations
- For COVID-19 patients, the same dosage of 8 mg three times daily has been studied with potential benefits in reducing ICU admissions and mortality, though this is not yet part of standard guidelines 3, 7
- When combining bromhexine with antibiotics for lower respiratory tract infections, maintain the standard dosage of 8 mg four times daily 6
While bromhexine can improve sputum characteristics and expectoration, clinicians should be aware of the European Respiratory Society's conditional recommendation against routine use in children with bronchiectasis due to potential adverse effects, and should carefully evaluate the risk-benefit ratio for each patient.